早期十全大补汤联合肠内营养乳剂治疗胃癌术后(气血两虚证)喂养不耐受临床评价

Early Application of Shiquandabu Decoction Combined with Enteral Nutrition Emulsion for Feeding Intolerance after Gastric Cancer Surgery( Deficiency of Both Qi and Blood)

目的探讨早期使用十全大补汤联合肠内营养乳剂(TP)治疗胃癌术后(气血两虚证)发生喂养不耐受(FI)的影响因素及对营养指标、中医证候积分的影响。方法回顾性分析术后早期行十全大补汤联合TP治疗的80例胃癌术后(气血两虚)患者的病历资料,根据是否出现FI分为耐受组(34例)和不耐受组(46例)。FI的相关影响因素进行单因素及多因素分析,并观察FI对患者营养指标、中医证候积分的影响。结果单因素分析显示,患者术后第1天下床活动时间、开始肠内营养(EN)的时间、使用营养泵、早期灌肠与FI的发生密切相关(P <0. 05);多因素Logistic回归分析显示,患者第1天下床活动时间≥2 h[OR=0. 022,P=0. 001,95%CI(0. 002,0. 223)]、使用营养泵[OR=0. 021,P=0. 000,95%CI(0. 003,0. 162)]是FI发生的独立危险因素;术后10 d,耐受组患者白蛋白(ALB)、血红蛋白(Hb)升高水平优于不耐受组(P <0. 05),中医证候积分显著低于不耐受组(P <0. 05)。结论胃癌术后(气血两虚证)患者早期给予十全大补汤联合TP治疗开始后,患者第1天下床活动时间不短于2 h、使用营养泵能有效减少FI的发生,并改善了患者的营养状态,减轻了中医临床症状。

Objective To investigate the influencing factors of early application of Shiquandabu Decoction combined with enteral nutrition( EN) emulsion for feeding intolerance( FI) after gastric cancer surgery( Deficiency of both Qi and Blood) and the effect on the nutrition index and traditional Chinese medicine(TCM) syndrome scores. Methods The medical records of 80 patients with postoperative gastric cancer( Deficiency of both Qi and Blood) treated with Shiquandabu Decoction combined with Enteral Nutrition Emulsion(TP) in the early postoperative period were selected and divided into the tolerance group and the intolerance group according to whether FI appeared after treatment. Relevant clinical data were analyzed,and statistical analysis was conducted on the relevant factors that might affect the occurrence of FI in patients,as well as its influence on nutritional indexes and TCM syndrome scores. Results Univariate analysis showed that the activity time out of bed on the first postoperative day,the time to start EN,the use of nutrition pump and early enema was closely related to the incidence of FI( P < 0. 05). Multivariate Logistic regression analysis showed that the activity time out of bed on the first postoperative day was ≥ 2 h( OR = 0. 022,P = 0. 001,95% CI = 0. 002,0. 223),and the use of nutrition pump( OR = 0. 021,P = 0. 000,95% CI = 0. 003,0. 162) were independent protective factors to reduce the occurrence of FI. Ten days after surgery,the Alb and Hb levels of patients in the tolerance group were higher than those in the intolerance group( P < 0. 05),and the TCM syndrome scores of patients in the tolerance group were significantly lower than those in the intolerance group( P < 0. 05). Conclusion Early application of Shiquandabu Decoction combined with Enteral Nutrition Emulsion(TP) used for Deficiency of Both Qi and Blood after gastric cancer surgery can improve the activity time out of bed to no less then 2 h on the first postoperative day. The use of nutrition pump could effectively reduce FI,improve the nutritional status of patients,alleviate the clinical symptoms of TCM syndrome,and promote the recovery of patients.